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New Jersey Office of the Attorney General

June 2012Re: certificate of AuthorizationDear New Jersey certificate of authorization Holder: Your New Jersey certificate of authorization will expire on August 31, 2012. 45:8-56requires biennial renewal of the certificate of authorization . Be advised that any corporation (except a professional service corporation established pursuant to the Professional Service Corporation Act ( 14A:17-1 et seq.)) offering or providing professional engineering and/or land surveying services in the State of New Jersey must obtain a certificate of authorization from the State Board of Professional Engineers and Land Surveyors to perform these functions. Any corporation offering or providing said services without the requisite certificate of authorization is in violation of 45:8-56. For this biennial renewal period of September 1, 2012 to August 31, 2014, all certificate of authorization renewal applications must be submitted along with a copy of the current Annual Report filed with the Division of Revenue in the New Jersey Department of the Treasury as set forth in 13 1.

Professional Service Corporations (N.J.S.A. 14A:17-1 et seq.) are not required to obtain a Certificate of Authorization. New Jersey Office of the Attorney General

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Transcription of New Jersey Office of the Attorney General

1 June 2012Re: certificate of AuthorizationDear New Jersey certificate of authorization Holder: Your New Jersey certificate of authorization will expire on August 31, 2012. 45:8-56requires biennial renewal of the certificate of authorization . Be advised that any corporation (except a professional service corporation established pursuant to the Professional Service Corporation Act ( 14A:17-1 et seq.)) offering or providing professional engineering and/or land surveying services in the State of New Jersey must obtain a certificate of authorization from the State Board of Professional Engineers and Land Surveyors to perform these functions. Any corporation offering or providing said services without the requisite certificate of authorization is in violation of 45:8-56. For this biennial renewal period of September 1, 2012 to August 31, 2014, all certificate of authorization renewal applications must be submitted along with a copy of the current Annual Report filed with the Division of Revenue in the New Jersey Department of the Treasury as set forth in 13 1.

2 Submit the confirmation copy of the filed annual report, which was obtainable online, only at the time the report was originally filed, or submit a copy of either status report listed below, filed with the Division of Revenue in the New Jersey Department of Treasury, as set forth in 13 Any further information needed regarding any of the reports, may be obtained online at , or call (609) 292-1730. Current Certificates of authorization expiring after August 31, 2012, will require an additional late fee. On October 1, 2012, all nonrenewed applications will automatically be suspended and must be reinstated. This means the renewal fee plus the reinstatement fee will be fee schedules: Renewal Fee: July 1, 2012 to August 31, 2014 $ Late Fee: September 1, 2012 to September 30, 2012 $ Reinstatement Fee: October 1, 2012 to August 31, 2014 $ The renewal application and instructions are being sent with this letter.

3 In addition, you will soon be able to go online to to download a copy of the renewal application. Please complete the renewal application and submit it with the renewal fee of $ Very truly yours, Paul Ray Acting Executive Director State Board of Professional Engineers and Land SurveyorsNew Jersey Office of the Attorney GeneralDivision of Consumer AffairsState Board of Professional Engineers and Land Surveyors124 Halsey Street, 3rd Floor, Box 45015 Newark, New Jersey 07101(973) 504-6460 Professional Service Corporations ( :17-1 et seq .) are not required to obtain a certificate of Jersey Office of the Attorney GeneralDivision of Consumer AffairsState Board of Professional Engineers and Land Box 45015 Newark, New Jersey 07101 Check as appropriate: Engineering Land Surveying Engineering & Land Surveying Building Design Services** Must complete Details of Ownership if offering Building Design Services pursuant to Section This form must be typewritten or printed clearly, and your certificate of authorization number must be noted above.

4 Include a telephone If any space is inadequate, use a separate sheet of Return the completed, signed and notarized application with a check or money order payable to State Board of Professional Engineers & Land Surveyors and mail all documents to the address noted Business addresses listed on this application must be A notary seal is required in the two areas provided on page two of the form. Also, on page two, provide the signatures of a corporate officer and the designated licensee-in-charge where Biennial renewal of the certificate of authorization is required, along with a copy of the current Annual Report filed with the Division of Revenue in the New Jersey Department of the Renewal Application for certificate of AuthorizationPeriod from: September 1, 2012 Period to: August 31, 2014 Renewal Fee: $ Renewal Due Date: July 31, 2012If Not Renewed By: August 31, 2012 The Late Renewal Fee is: $ Reinstatement Fee.

5 $ if received after September 30, 2012If a completed renewal application and check or money order are not received BY THE DUE DATE OF JULY 31, 2010, the State Board of Professional Engineers and Land Surveyors cannot guarantee that you will receive your new certificate of authorization prior to the expiration (Required)Applicant (Name of corporation and telephone number including area code)Address of the principal Office in the state of incorporation (1)State of IncorporationDate of this applicationIs your company currently registered and in good standing with the New Jersey Department of the Treasury to do business in New Jersey ? Yes NoAddress of the principal Office in New Jersey (if different from above) (2) noneI am aware that the certificate of authorization may be revoked if any agent, employee, director or officer of the corporation violates or causes to be violated any provisions of those laws or regulations governing the practice of engineering and land surveying in New addresses of other offices where professional services will be offered or provided in New Jersey .

6 (Each Office must be sequentially numbered beginning with 3; as 3, 4, 5, etc.)corporate offIcersNameTitleHome addressSignatureProf. License NumberPersons in responsible charge listed below must include the numerical identifier of their work location following their name in the column below. If a licensee is in responsible charge of more than one Office , use a separate line for each Office and attach an explanation. If a licensee is also in responsible charge of engineering or land surveying services for other business entities or as a sole proprietor, he/she shall place an X in the column next to his/her signature and attach the details of all such associations. List all personnel in responsible charge who act on behalf of the corporation as a professional engineer or land surveyor. The first licensee listed will be considered the designated Board contact. Thisindividual will be sent all of the mail from the Board Office and be the person listed on the renewed hereby certify that I am familiar with the laws and regulations governing the practice of engineer-ing and land surveying in New Jersey and the definition of responsible charge therein and my responsibility under this definition.

7 NameHome License NumberProf. Surv.(Use an additional sheet of paper if necessary.) Any changes in the above information must be reported to the Board within 30 days after such changes become oath, I declare that the foregoing statements, to the best of my knowledge and belief, are true and made in good me personally appeared the signer of the above, who acknowledged himself/herself to be the authorized above-named officer of the above-named corporation and that he/she being authorized to do so, executed this application for the purposes stated by signing the name of the corporation by himself/herself as the authorized officer. In witness thereof:ApprovedFeeState Board of Professional Engineers and Land SurveyorsDate certificate of authorization NumberDateFor Office Use OnlyCounty and StateSigned (Notary Public)Seal of Notary PublicSign Here (Designated In-Responsible-Charge Licensee): _____Typed Name:Title:Subscribed and sworn to before me this _____day of _____, and StateSigned (Notary Public)Date Commission ExpiresSeal of Notary PublicName of CorporationSign Here (Authorized Officer): _____Typed Name:TitleDateDate Commission ExpiresDesignated Board contact (Will receive all mail from the Board Office .)

8 Name of DirectorFor Office Use OnlyDetaIls of ownershIpRequired Information in accordance with 45:4B-8: (1) Provide the names of all directors, two-thirds of whom must be professional engineers, and (2) Provide the number of all issued and outstanding shares of the corporation, and (3) Provide the number of issued and outstanding shares owned by professional engineer shareholders (minimum of 20% required).Note that this applies to any corporation, which may by law render or offer to render engineering services, and which enters into a contract with an owner to provide Architectural and Engineering services, in accordance with 45 BuIlDIng DesIgn servIcesNew Jersey Professional Engineer License Number(Use an additional sheet of paper if necessary.)This page should only be completed if you are offering or providing Building Design Services, pursuant to 45:B4-1 et seq .Corporate Stock Information:Total Issued and Outstanding SharesTotal Issued and Outstanding Shares Owned ByProfessional Engineers


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